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Monday, March 21, 2016

As life would have it (light in the dark as I search for the resolution)

   It's funny.  My facebook memories recently reminded me of a blog post from last year at this time, when I talked about letting my training come back to me, finding solace in swimming, and silver linings.  I had recalled the deep fatigue overtraining/racing stuff that had been going on in 2014, as I desperately counted down the days until my next set of x-rays.  And now, here I am, another year later, in a familiar position for March, apparently-not running.  Unsure.  Even though injuries and fatigue are different animals, my current position is oddly similar to 2014-no one really knows what's going on or how long it's going to last, but the "why" is as clear as day when looking into the rearview mirror.  And...I'm just frustrated.  When I was going through all of the fracture stuff last winter, I had thought to myself on multiple occasions, well, at least it's not some unspecified lingering tendon stuff that won't go away like I've had in the past.  Clear (kind of, sort of, not really, as I'd learned a few months later when further x-rays revealed that ischial tuberosity fracture wasn't as healed as it should have been) x-rays seemed objective.  When I then went through the labral repair stuff over the summer, I had also thought, well, at least there's a protocol of when I'll be better.  The whole time, I'd more or less just brushed any sort of other soft tissue dysfunction, imbalance, weirdness, tightness under the rug and trained through it until I couldn't train through it anymore.

Discovery: once I get Dave over ~4500 or so yards in the pool, I can sometimes beat him.  Here I am celebrating winning the last 100.
   Anyways.  I looked back, and at the time of my last blog post, I'd just undergone some anti-inflammatory injections into my butt.  They helped a bit.  After a week, I tried to start a walk/jog program.  I got up to 4min run/1min walk before laying awake that night, having to once again admit that running wasn't working out.  I continued to cut back riding, getting down to 1-3 hours max every other day.  It still hurt.  I emailed my surgeon.  He told me that in fact, outside of the warped world of the long course triathlete mind, that's a lot of pressure sitting on an irritated area.  I stopped riding for about 10 days.  I went to QT2 pro camp at the time swimming and using the elliptical only.  While there, with the help of some deep tissue massage, diligence at therapy-type strengthening, and sitting completely off-kilter on the smallest saddle ever to unload the area in question, I was able to get back onto my bike to some degree, maxing out at about three hours.  At the time, I was slightly encouraged, until I came home sick (as always-I hold a grudge against Clermont), sat around a bit, and found myself seemingly back to square one.  After a couple more rides, I finally just had to throw in the towel on the bike.  Like it or not, the pressure of a bike saddle, no matter how many different saddles I tried (five, I want to say) was just too uncomfortable on butt and groin tendinopathies.  At best, things felt "mildly uncomfortable"; but I was simply tolerating my time in the saddle, and then dealing with the aftermath.  Riding just wasn't fun.  Not that hours staring at the basement wall is ever a party, but I think triathletes kind of get what I mean here.  Being 100% honest with myself meant that admitting, well, yes, I technically could ride, but I would be (both literally and figuratively, I suppose) just spinning my wheels in place, not getting to where I wanted to be health-wise.  Adding running in on top of that was just not a realistic proposition.

The ratio of cool bird to training pictures I took in Florida was about 62:1

I also took a "sunset over the lake" picture when I was feeling whimsical and artsy

  So, a couple of weeks ago, I called it and went back to swimming and the elliptical, which both remain pretty comfortable, and continued with the strength work, active release treatments, and massage.  Still...things still hurt.  At the current time, I've had three months of proximal hamstring attachment pain, and my adductor tendon area has hurt pretty much since I started doing anything post-op.  Somewhat frustratingly, I had that MRI in mid-January that didn't really clarify why I'm having the pain, which has led me to feel like I have to explain myself and justify that stuff is actually wrong, I'm not just (only) a head case.  My surgeon has postulated that there might be pudendal nerve involvement, which maps to the same pain areas.  I'm scheduled to have a nerve block done for that, but I couldn't get in until May 5, and, to be honest, I'm just not convinced that's the issue.  I do have pain in those areas and it hurts more when I sit, but I'm lacking a lot of the other symptoms of nerve involvement, and, in my PT brain, some of the activities that bother it just seem like tendon involvement.  I've had cases of recalcitrant, long-lasting patellar tendonitis and ITB syndrome in the past that have lasted months, and haven't shown a darn thing on MRI.  Those two areas are pretty straightforward to diagnose.  So, knowing that, and knowing that we now know more and more about how certain tendon pain is caused by degenerative vs inflammatory conditions that don't necessarily show on scans, I began to look for other answers.  

   This landed me in the office of Dr. Day, a local sports med orthopedist who has referred runners to me in the past, and who I've sent athletes and Dave to (more on that in a bit).  We discussed PRP injections.  It's not necessarily a proven procedure, and there isn't too much evidence on it for proximal hamstring and adductor issues, but it's becoming more common in sports medicine circles, and, at this point, I have little to lose.  So, I'm going to be giving that a try in a few days.  More importantly, Dr. Day spent a bunch of time looking through a somewhat frighteningly thick stack of notes on me, including all of my surgical visits, and immediately began to tell me all of that stuff that I didn't believe or want to hear at the time months ago about how I was just flat out doing too much too soon post-op.  Stressed out tissues that are trying to heal don't think relative to what a person used to do; for a period of time, they think in absolutes.  Looking back, I can readily admit that I worked through too much pain, downplayed too much, thought I was too tough, didn't respect the healing process enough, got too eager too soon, and, like the teenager that texts and drives and smashes into a mailbox, thought that I could get away with things that were just a bad idea.  When discussing the injections, Dr. Day was clear with me-there's going to be a period of down time afterwards, and I'm going to have to respect that.  Once I'm through that, my build back is going to have more concrete barriers placed on it, with less wiggle room for me to go hog wild as soon as I'm given even a yellow light.  Honestly, the type A athlete in my otherwise semi-laid back self had to admit a sense of relief.  I don't enjoy trying to govern myself, and I've had to basically learn that I needed to shut myself down the hard way throughout these past few months.  To have someone that I can trust tell me, more or less "this is what you need to do for a smooth return" was welcome.  
Got to love medical intake forms. I wanted to be bitter and just put "I don't know what to put for when problem started, I've had about 9000 imaging studies of my pelvis, and I have tried EVERYTHING."  But I didn't.  And the doctor had my records anyways.
   Then, there's what's been concurrently going on with the rest of the household.  I'll start with Dave, because that seems simplest (maybe this says something about me that I'm going to get into more detail about a dog than a husband, but she's softer).  About a week before my butt gave out, Dave started having pain on the outside of his ankle.  Fast forward two months of not running and continuing to have pain with biking, kicking in swimming, and on the elliptical, and I finally convinced him to see the doctor and get an MRI.  As life would have it, the MRI revealed a small split in his peroneal tendon.  So, he's four weeks in a boot (currently 1.5 weeks in), and then we'll see.  If nothing else, it does make it somewhat easier for both of us to be laid up at once-misery loves company, right?  Plus, at least I can watch him suffering on the rowing machine in a boot while I suffer on the elliptical at the gym-it's directly in my line of vision.  Which brings me to the Moose.  The Moose's saga has been somewhat played out on social media, but I'll describe a little more here, in case anyone was hugely interested in my dog's kidney function.  Just for a little background, we live in an area notorious for having 17 million deer around that eat everything in our yard while giving me the middle deer finger (something like that).  Our street also dead ends at some woods that are known as sort of an unofficial dog park (inhabited by deer, as well).  So, all this means is that the woods are loaded with ticks.  I've been taking my dogs up there several times a week since I've had them, and even with preventatives, both ended up testing Lyme positive 3 years ago.  Most dogs, though, as I've had explained to me, don't end up developing symptoms, but a small percentage will end up with joint problems, and an even smaller percentage end up with kidney problems.    
Dave getting his boot.  I'm sort of disappointed that I never got to wear a pelvis brace that I could pump up, Reebox pump style.  Life is mean and unfair.

Random Hansen household scene, before Dave got diagnosed.  Dave trying to do foot exercises.  Dogs in the way.  TENS unit pads stuck to the coffee table.  Softballs for butt self massage on the floor.  
   Well.  In mid-December, Moose (who is about nine, we don't know exactly-shelter transfer mutt), threw up a few times one week.  No big deal, she acted fine otherwise, went on walks, had her normal ravenous appetite otherwise, etc.  I was on the alert at the time, but forgot about it until about a month later, when she threw up a few more times.  This time, I made a vet appointment for her.  I'd also noticed that her normally bad breath seemed worse, and her normal shedding everywhere seemed more pronounced.  But, she was still scarfing down food and eager to head up to the woods, so I legitimately just thought she might have found a nice pile of crap in the back yard that she was snacking on regularly.  The vet examined her, didn't find anything wrong, and drew some blood on a Friday.  The following Monday, my dog world was suddenly turned upside down.  Moose's blood work came back showing kidney disease, and not just mild kidney disease.  I was completely blindsided.  I spent the next three days bringing the dog who had been my loyal companion and feeling-sensor for the past 7.5 years into the vet for full days to have her kidneys flushed via IV, more tests run, medications administered, etc, etc.  At the end of that time, her numbers hadn't improved, and her prognosis was uncertain.  We brought her home, and spent the rest of that week and the weekend trying to get the dog who we used to joke was like a shark around food to eat (and keep down) anything, shoving pills down her throat, and, at times, carrying her back into the house because she couldn't make the jump up the stairs and was shivering from the cold.  To say that I was completely devastated that I had gone from thinking nothing was wrong to wondering if the Moose would survive the night in such a short amount of time, seemingly with little warning, would be an understatement.  
Poor puppy in a cone!

Naturally, the fact that Bailey was uncharacteristically acting like she loved her sister and laying with her made me overly emotional
  This was all happening from a Wednesday night through Sunday.  I was supposed to leave for camp the following Thursday.  I was 100% convinced that Moose wasn't going to make it until I even left for camp, let alone until I made it home.  Finally, Monday morning, Moose stopped eating entirely.  I called our vet, who told me to take her to the emergency vet.  I brought her in, convinced that I wouldn't bring her home.  Instead, I ended up opting to having her admitted and then transferred to internal medicine to see the specialist.  Whether or not he could do anything remained to be seen, but despite the cost, I needed to know that I had done absolutely everything reasonable to help my dog.  The Moose spent another few days with the internist, who was great with calling me and communicating in detail what was going on.  Moose was diagnosed with a protein-leaking neuropathy, which was related to her Lyme disease, as no other causes could be found.  She also presented with high blood pressure.  She didn't improve much while admitted, so the internist thought that it would be best to send her home with medications to manage her hypertension, Lyme disease, and, at the time, nausea and lack of appetite.  What's going on, he explained, is terminal, but he thought that it would be worth a try to see if we could medically manage her and give her more life.  I was completely unconvinced.  Her numbers were terrible, and she hadn't been acting even remotely like the dog I was used to.  My heart continued to hurt thinking about putting my little girl through more, but when I picked her up, she seemed a bit perkier.
We also had a sweet snowstorm that week.  Bailey deep snow.
   Still, I postponed leaving for camp for a day, just to spend a little more time with her and to get Dave set with her management.  I spent my drive to the airport choking back tears, thinking that I wouldn't get one of her eager greetings when I came home.  For the first couple of days, Dave continued to tell me that he was struggling to get her to eat.  Then, he took advantage of me being away to cook a whole bunch of meat and have a bunch of dudes over to eat said meat.  Apparently, Moose also enjoyed some turkey that night, and after that began to come around a bit more.  I didn't totally believe him when he told me she was doing better, though, until I came home to my dog, well, acting like my dog.  Since I've been home for the past 3 weeks, I've been able to enjoy every last second of quality Moose time I've gotten.  She's scarfing down the special kidney diet she wouldn't touch before I left, and taking her pills without issue.  Part of what had hurt so badly during the shock of everything initially was the thought that I'd never be able to take her down to the woods again, but we've been going on our normal 2.5 mile loop several times a week, and she's been running around with a giant smile on her face.  Tomorrow, I'll take her in for more blood work, so we'll see what that says.  Nothing about what she has is reversible, and I have no idea how long this current good spell will last.  But, I'm incredibly grateful for every last quality second that I'm getting with her right now, and I won't take a second of it for granted.  
See?  Dogs in the woods!

Happy dog in the woods!

Matching orange and white dogs in the woods!
   So, that's that.  That's life, I suppose.  Just when I thought I had everything figured out, I realized that I actually had nothing figured out yet again.  I'm still learning.  I think that I'm finally learning to just roll with the punches a little bit more.  I don't know what the resolution of all of this is going to take, and unfortunately, as much as I want to believe that the triathlon world owes me by now, it actually doesn't work like that.  I underestimated the magnitude of my crash injuries and how long they would take to heal.  I underestimated how much stress a hip surgery puts on the body and how long it would take to heal.  And now, I'm just paying the price from all of that.  If I could go back in time, I'd do a trillion things differently and not be a dumbass.  But, I can't do that, so all I can do moving forward is take it slow and steady-and that's ok.  I'm just sick of pain.  As an outpatient physical therapist for the past 7 years, I've seen plenty of patients with chronic conditions and chronic pain, and now, I just get it.  Pain sucks.  There's a reason that we have so many professions devoted to finding different ways to diagnose, manage, and treat it, so if I have to finally respect what I'm feeling, then so be it.  And yes, I still get pretty downtrodden sometimes.  I've learned that I can't just tell myself to snap out of it, but I've figured out a whole bunch of different stuff that I can do to turn my mood around.  Walking the dogs in the woods, getting seeds started indoors for my eventual garden, busting out spring decorations, getting caught up on my inbox-all simple tasks that still make me happy.  I also have to throw swimming in there.  For the first time in my life, I'm finding value in swimming simply for the sake of swimming, not as the means to an end (triathlon).  If that was the case, I would have lost motivation in the water long ago, when I realized that I wasn't racing anytime soon.  But, if anything, the opposite has happened.  I think a good part of it is that pushing my body physically is a part of my being, and the water is the only place that I can do that where injury pain doesn't override training pain.  So that helps.  For now, I'll get my injections Friday, listen to the powers that be, rest like I should, pet my furry dogs while I can, and climb the hill inch by inch, not mile by mile, in order to hopefully avoid any more backsliding and roadblocks in my way.

Since I already included a lot of dog pictures, I'll finish with a unicorn with a sort of inspirational message about believing and crap.  Because, unicorns.